HomeMy WebLinkAbout0004 BLACKBERRY LANE - Health Fall
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THE COMMONWEALTH OF MASSACHUSETTS
B O
A R D OF HEALTH
.... . . . .V*.........OF...... .
Appliration for .................................
Disposal Works Tonstrurtion Vern fit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System.at:
.......... .........................
....... ........
_Location-Address or Lot No.
Vl%., ....................................... ..........................5..A!:! :S..................................
Owrjer Address
.......... —2 ..............
. ......................... ...................................... ...... .. .................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......-3--------------------------------Expansion Attic Garbage Grinder (
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (
Other fixtures .........................................................................
------------------------*............WW
Total daily flow..............3..... ...................gallons.
Design Flow..........'a i5 ..6.......................gallons per person per day. To
Septic Tank—Liquid*ca.pacity............gallons Length................ Width................ Diameter............_._. Depth....._..._......
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area ...................sq. ft.
Seepage Pit No-----I.............. Diameter.......P........ Depth below inlet......ke.......... Total leaching area.................sq. ft.
Z Other Distribution box Dosing tank
0-4 Percolation Test Results Performed by.......................................................................... Date........................................
04
14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................
Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water........................
pG ---------------------------**"*.......................*.............."...*......"-------------"',*.......................................................
0 Description of Soil........................................................................................................................................................................
......................
----------------- ---------------*"------------------**---------------- ---------*---------*--------------
.......................................................................................................................................................................................................
A*0,0 D j�,-,e_
U Niture of Repairs or Alterations—Answer when applicable_.___----------- -- --- --------- .. ..............u3K.L......
----------
...C.10.1..............................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIME 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued byte boa5a_Q)��lh.
Sign .......... .............................. ..............................._77 ed......
Date
Application Approved y.................B ........................... ........
Date
Application Disapproved for the following reasons:...........................................................................................................
.....................................................................................................................................................................................................
Date
PermitNo......F2 , 7 7............................................. IssuedL....................................................
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
r "-'sfTOWN OF BARNSTABLE. L
,,�` 4i
1°CAN_ I,. s SEWAGE # �-Tq
VILLAGE ASSESSOR'S MAP.&.LOT
INSTALLER'S NAME & PHONE NO,
SEPTIC TANK CAPACITY n STi C.seSS as L S
LEACHING FACILITY:(type) L(2•?CA5'( PfT- (size)
NO. OF BEDROOMS 3 PRIVATE WEL PUBLIC WAT�ER �
a
BUILDER OR OWNER y 0 VA-C-5
DATE PERMIT ISSUED: l 13- {
1 ` l-
i.DATE COZIPLIANCE ISSUED:
L�VARIANCE GRANTED: Yes + No y
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...-T.. w-�......... �t�.y...i -5 .j6�1- '.....................................
Appliration for Disposal Works Tonutrurtion 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.....»-•..- J'1-- 1?, L 4< ........... ................ �: ....:`. ..t c.- ................-..........»».
�-
_Location-Address - or Lot No.
»............»M J».....J CJ-,A f.f=.. vL�
---........................ .........................5 V4
/� Owner Address
aI< r 1�� .. Y�-..✓ .. .........................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......'................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...--••-----------------•••--•---•-•...........
WW Design Flow.......... .. .....................gallons per person per day: Total daily flow....._.___- ------ ...............gallons.
WSeptic Tank—Liquid ca.pacity._..........gallons Length................ Width................ Diameter................ Depth............
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit NO_...I.............. Diameter.....!..P._....._ Depth below inlet.....�1........ Total leaching arm........___-.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
"" Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------
•.................
......................... .......... ........ ------------------
---
•---------------
•-... ....................._.......
0 Description of Soil........................................................................................................................................................................
W
W
V ._•.....
_----------------
--•----------
------ --•-•-•---------- •-••-•
... -------••-•-•--•• -----------------------------------------------
•-•------------
---------
••••••-•••-- ---•-----------
UNature of Repairs or Alterations—Answer when applicable.........nl.) n.......
a
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.._ � ~`i �� ..............................-
Date
Application Approved By................. .� ,�, •-••-••1 ..-. .:...fs_ ..
_ �""`j-•---•-•.............•-•---^ Date
Application Disapproved for the follourng reasons:..........................................................................................................---
.........--•.................••-•.......................---•••--•-------••••----••-••-------...-•--•-----•----------••----....--•••----••-......--•-•-••-...................••-------•----•-.....---.._
Daft
PermitNo..................................................___. Issued...........................................-..........
Date
————————————————————————————————---——————————————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
vv...........OF... ...............................
(9rrtifiratr of Toutplia"r
THIS IS TO CERTIFY, That the_Individual Sewage Disposal System constructed ( ) or Repaired ( C)_
by.............. ....<-.=.... Y==-=•-----------•-t......:.........'.`:.5-----------•---• ......................----------------
{ \' `� Installer
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.._ 7=.. Q.2._...._. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............�..�c �/ =�� ._.. Inspector -1 �--_... --...........--•-•--------..._.....................
V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓.�-.......OF.........� !(2 ..............................
No..,,_.?-.._7 Z FEE...: :?.'--
Diopouttl Works, Tonstrttrtiott Permit
Permission is hereby granted....—
ranted 1 ....................b.--•-''......................................................................................
-
to Construct ( ) or Repair (�-an Individual Sewage Disposal System t
L ._r 5 i �L. 1!tr����. 1 4"%----•._...--...!`� -- ..�..................................................
at No.•---•••---------•-----•......__.••-- -!( --_....._.... �. z
Street i
as shown on the application for Disposal Works Construction Permit J'14
7Dated..........................................
-----••.................. -- ........ _- —.. ........................
/ � - ��' lloanl of Hcalth
DATE...-•---------------------•-•-_-•----..-�_�..........._......-----•---•-•---